Original Research
Prognostic Value of Risk Factors, Calcium Score, Coronary CTA, Myocardial Perfusion Imaging, and Invasive Coronary Angiography in Kidney Transplantation Candidates

https://doi.org/10.1016/j.jcmg.2017.07.012Get rights and content
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Abstract

Objectives

This study sought to perform a prospective head-to-head comparison of the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates.

Background

Current guidelines recommend screening for coronary artery disease in kidney transplantation candidates. Furthermore, noninvasive stress imaging is recommended in current guidelines, despite its low diagnostic accuracy and uncertain prognostic value.

Methods

The study prospectively evaluated 154 patients referred for kidney transplantation. All patients underwent CACS, coronary CTA, SPECT, and ICA testing. The clinical endpoints were extracted from patients’ interviews, patients’ records, and registries.

Results

The mean follow-up time was 3.7 years. In total, 27 (17.5%) patients experienced MACE, and 31 (20.1%) patients died during follow-up. In a time-to-event analysis, both risk factors and CACS significantly predicted death, but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT predicted neither MACE nor death.

Conclusions

Compared with traditional risk factors and other cardiac imaging modalities, CACS and coronary CTA seem superior for risk stratification in kidney transplant candidates. Applying a combination of risk factors and CACS and subsequently coronary CTA seems to be the most appropriate strategy. (Angiographic CT of Renal Transplantation Candidate Study [ACToR]; NCT01344434)

Key Words

coronary angiography
coronary artery calcium score
coronary computed tomography angiography
renal transplantation
single-photon emission computed tomography

Abbreviations and Acronyms

ACC/AHA
American College of Cardiology/American Heart Association
CACS
coronary artery calcium score
CAD
coronary artery disease
CKD
chronic kidney disease, (stages: 1 to 5, D: dialysis)
CTA
computed tomography angiography
HR
hazard ratio
ICA
invasive coronary angiography
IQR
interquartile range
MACE
major adverse cardiac event(s)
QCA
quantitative coronary angiography
SPECT
single-photon emission computed tomography
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

This study was supported by the Karen Elise Jensen Foundation, the Bjørnows Foundation, the Danish Society of Nephrology Research Foundation, and the Health Research Foundation of the Central Denmark Region. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.